Provider Demographics
NPI:1447202775
Name:SHORR, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:SHORR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:501 EAST HARDY STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4504
Mailing Address - Country:US
Mailing Address - Phone:310-673-4900
Mailing Address - Fax:310-673-1319
Practice Address - Street 1:501 EAST HARDY STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4504
Practice Address - Country:US
Practice Address - Phone:310-673-4900
Practice Address - Fax:310-673-1319
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG51603208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078930Medicaid
CAGR0078930Medicaid
CAWG51603BMedicare PIN